Highlights•

All participants had high antibody titers after 3 months with the mRNA-BNT162b2 vaccine.

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Nevertheless, a highly significative antibody decrease was observed at 3 months, only when a dilution factor was applied.

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Non saturated quantitative signals are needed to study the real kinetics of antibodies.

Dear Editor,We read with great interest the recently published article of Tré-Hardy et al. reporting on the time-related changes in the serological response of healthcare workers having received the mRNA-1273 vaccine.(1Tré-Hardy M Cupaiolo R Wilmet A Beukinga I Blairon L. Waning antibodies in SARS-CoV-2 naïve vaccinees: results of a three-month interim analysis of ongoing immunogenicity and efficacy surveillance of the mRNA-1273 vaccine in healthcare workers.) Among 205 individuals, 161 (78.5%) were initially seronegative at baseline while 44 (21.5%) already developed antibodies directed against SARS-CoV-2. The antibody response was assessed 2 weeks after the first vaccine injection (T1), 2 weeks after the second vaccine injection (T2) and 3 months after the first injection (T3). The quantitative analysis of the anti-SARS-CoV-2 IgG antibodies directed against the subunits (S1) and (S2) of the virus spike protein was carried out using the LIAISON® SARS-CoV-2 IgG kit (DiaSorin®, Saluggia, Italy). Almost all samples at T1 and all samples at T2 and T3 in the seropositive cohort were above the maximum quantification value of the assay kit, i.e. >400 AU/mL on neat samples. In the discussion, the authors reported that, in previously seropositive subjects (n=44), no drop in antibody between T2 and T3 was observed.In order to share our experience on that important topic, we would like to present the results we obtained 3 months post-vaccination in the CRO-VAX HCP study (EudraCT registration number: 2020-006149-21), an ongoing multicenter study in healthcare workers having received BNT162b2, another mRNA vaccine (Pfizer-BioNTech, Mainz, Germany).(2Favresse J Bayart JL Mullier F Dogne JM Closset M Douxfils J. Early antibody response in health-care professionals after two doses of SARS-CoV-2 mRNA vaccine (BNT162b2).) Among the 200 individuals who were followed up to 3 months, 58 (29%) were seropositive and 142 (71%) were seronegative at baseline.(3

Favresse J, Bayart J-L, Mullier F, Elsen M, Eucher C, Eechhoudt SV, et al. Antibody titers decline 3-month post-vaccination with BNT612b2. 2021.

) Antibodies against the SARS-CoV-2 receptor binding domain of the S1 subunit of the spike protein (anti-S; Elecsys® anti-SARS-CoV-2 spike quantitative ECLIA, Cobas 801, Roche Diagnostics®, Machelen, Belgium) were measured. As the Roche system permits samples dilution to increase the range of measurement, we diluted our samples 10 or 100 times when signal was out of range according to the manufacturer recommendations. Similar timepoints as Tré-Hardy et al., i.e. baseline, 14 days, 42 days and 3 months, were collected in our cohort and analyzed.Using neat or 10-fold diluted samples, we did not observe an antibody drop in seropositive individuals between T1, T2 and T3 (p >0.05, Figure 1), a finding which is similar to that of Tré Hardy et al.(1Tré-Hardy M Cupaiolo R Wilmet A Beukinga I Blairon L. Waning antibodies in SARS-CoV-2 naïve vaccinees: results of a three-month interim analysis of ongoing immunogenicity and efficacy surveillance of the mRNA-1273 vaccine in healthcare workers.) However, a highly significant drop in antibody titers was observed at 3 months if a 100-fold dilution was performed (pFigure 1). Such dilution factor permits to increase the range of measurement until 25,000 U/mL on the Roche assay. Considering seronegative individuals, a highly significant antibody drop was also shown when a 10- or 100-fold dilution was applied (pTable 1). The application of a 10 or 100-fold dilution (depending on the sample) with our kit permits to show an important difference between the previously seronegative and seropositive subjects (1,863 U/mL versus 15,856 U/mL at day 42 and 1,262 U/mL versus 8,919 U/mL at 3 months), a difference which is not observed when neat samples are used (Table 1). Analytical kits that do not allow a wide range of measurement may thus hide a difference of serological response between previously seronegative and seropositive subjects and does not permit to appreciate the drop in antibody titers in both groups (Table 1).

Figure 1Evolution of SARS-CoV-2 spike antibodies (U/mL) in previously seronegative (blue) and seropositive individuals (red) according to the time since administration of the first vaccine dose. Means (95% confidence intervals) are shown. Three different representations according to the dilution titers applied are shown (no dilution: up to 250 U/mL; 10-fold dilution: up to 2,500 U/mL; 100-fold dilution: up to 25,000 U/mL). All dilutions were automatically performed by the analyzer. Results < 0.4 U/mL (limit of quantification) were rounded to 0.4. $ = statistically different from all other groups (i.e. p <0.0001).

Table 1Evolution of SARS-CoV-2 spike antibodies (U/mL) in previously seronegative and seropositive subjects according to the dilution factor. Means (95% confidence intervals) are shown.

Currently, data about the long-term kinetics of antibodies in vaccinees are scarce. Two studies found an time-dependent antibody decline with the mRNA-1273 vaccine in only 33 and 34 participants while Tré-Hardy et al. followed more than 200 subjects.(4Doria-Rose N Suthar MS Makowski M O'Connell S McDermott AB Flach B et al.Antibody Persistence through 6 Months after the Second Dose of mRNA-1273 Vaccine for Covid-19., 5Widge AT Rouphael NG Jackson LA Anderson EJ Roberts PC Makhene M et al.Durability of Responses after SARS-CoV-2 mRNA-1273 Vaccination.) Nevertheless, in previous investigations, sample dilutions were applied to allow a better discrimination between previously seronegative and seropositive subjects.(6Manisty C Otter AD Treibel TA McKnight A Altmann DM Brooks T et al.Antibody response to first BNT162b2 dose in previously SARS-CoV-2-infected individuals., 7Salvagno GL Henry BM di Piazza G Pighi L De Nitto S Bragantini D et al.Anti-SARS-CoV-2 Receptor-Binding Domain Total Antibodies Response in Seropositive and Seronegative Healthcare Workers Undergoing COVID-19 mRNA BNT162b2 Vaccination., 8Prendecki M Clarke C Brown J Cox A Gleeson S Guckian M et al.Effect of previous SARS-CoV-2 infection on humoral and T-cell responses to single-dose BNT162b2 vaccine., 9Capetti AF Stangalini CA Borgonovo F Mileto D Oreni L Dedivitiis G et al.Impressive boosting of anti-S1/S2 IgG production in COVID-19-experienced patients after the first shot of the BNT162b2 mRNA COVID-19 Vaccine.) Compared to the antibody response observed in past-COVID-19 patients, where none or few samples needed to be diluted,(2Favresse J Bayart JL Mullier F Dogne JM Closset M Douxfils J. Early antibody response in health-care professionals after two doses of SARS-CoV-2 mRNA vaccine (BNT162b2)., 9Capetti AF Stangalini CA Borgonovo F Mileto D Oreni L Dedivitiis G et al.Impressive boosting of anti-S1/S2 IgG production in COVID-19-experienced patients after the first shot of the BNT162b2 mRNA COVID-19 Vaccine., 10Tre-Hardy M Wilmet A Beukinga I Dogne JM Douxfils J Blairon L. Validation of a chemiluminescent assay for specific SARS-CoV-2 antibody.) the antibody response in vaccinees is significantly higher and will certainly require dilutions to obtain the real quantitative value with some assays (i.e. not rounded to the upper limit of measurement).In conclusion, we agree with Tré-Hardy et al. that a persistent antibody response was observe following the administration of the mRNA vaccine, as observed elsewhere using various assays.(1Tré-Hardy M Cupaiolo R Wilmet A Beukinga I Blairon L. Waning antibodies in SARS-CoV-2 naïve vaccinees: results of a three-month interim analysis of ongoing immunogenicity and efficacy surveillance of the mRNA-1273 vaccine in healthcare workers., 2Favresse J Bayart JL Mullier F Dogne JM Closset M Douxfils J. Early antibody response in health-care professionals after two doses of SARS-CoV-2 mRNA vaccine (BNT162b2)., 3

Favresse J, Bayart J-L, Mullier F, Elsen M, Eucher C, Eechhoudt SV, et al. Antibody titers decline 3-month post-vaccination with BNT612b2. 2021.

, 4Doria-Rose N Suthar MS Makowski M O'Connell S McDermott AB Flach B et al.Antibody Persistence through 6 Months after the Second Dose of mRNA-1273 Vaccine for Covid-19., 7Salvagno GL Henry BM di Piazza G Pighi L De Nitto S Bragantini D et al.Anti-SARS-CoV-2 Receptor-Binding Domain Total Antibodies Response in Seropositive and Seronegative Healthcare Workers Undergoing COVID-19 mRNA BNT162b2 Vaccination.) However, the absence of “antibody drop” between T1, T2 and T3 observed in their cohort of previously seropositive could depend on the analytical kit used and the application of a dilution factor in case of signal saturation if such procedure is permitted and documented by the manufacturer. The results of the CRO-VAX HCP study showed that the use of undiluted or diluted samples led to different conclusions regarding the antibody kinetics. The fact that the signal is not saturated with the Roche assay also permit to derived more precise pharmacokinetic models which could latter better predict the probable persistence of antibodies.(3

Favresse J, Bayart J-L, Mullier F, Elsen M, Eucher C, Eechhoudt SV, et al. Antibody titers decline 3-month post-vaccination with BNT612b2. 2021.

) Such data are important, especially since the question about a third dose has been raised.ReferencesTré-Hardy M Cupaiolo R Wilmet A Beukinga I Blairon L.

Waning antibodies in SARS-CoV-2 naïve vaccinees: results of a three-month interim analysis of ongoing immunogenicity and efficacy surveillance of the mRNA-1273 vaccine in healthcare workers.

Journal of Infection. ()Favresse J Bayart JL Mullier F Dogne JM Closset M Douxfils J.

Early antibody response in health-care professionals after two doses of SARS-CoV-2 mRNA vaccine (BNT162b2).

Clin Microbiol Infect. ()

Favresse J, Bayart J-L, Mullier F, Elsen M, Eucher C, Eechhoudt SV, et al. Antibody titers decline 3-month post-vaccination with BNT612b2. 2021.

Doria-Rose N Suthar MS Makowski M O'Connell S McDermott AB Flach B et al.

Antibody Persistence through 6 Months after the Second Dose of mRNA-1273 Vaccine for Covid-19.

The New England journal of medicine. ()Widge AT Rouphael NG Jackson LA Anderson EJ Roberts PC Makhene M et al.

Durability of Responses after SARS-CoV-2 mRNA-1273 Vaccination.

N Engl J Med. 384 (): 80-82Manisty C Otter AD Treibel TA McKnight A Altmann DM Brooks T et al.

Antibody response to first BNT162b2 dose in previously SARS-CoV-2-infected individuals.

Lancet. 397 (): 1057-1058Salvagno GL Henry BM di Piazza G Pighi L De Nitto S Bragantini D et al.

Anti-SARS-CoV-2 Receptor-Binding Domain Total Antibodies Response in Seropositive and Seronegative Healthcare Workers Undergoing COVID-19 mRNA BNT162b2 Vaccination.

Diagnostics. 11 (): 832https://doi.org/10.3390/diagnostics11050832Prendecki M Clarke C Brown J Cox A Gleeson S Guckian M et al.

Effect of previous SARS-CoV-2 infection on humoral and T-cell responses to single-dose BNT162b2 vaccine.

Lancet. 397 (): 1178-1181Capetti AF Stangalini CA Borgonovo F Mileto D Oreni L Dedivitiis G et al.

Impressive boosting of anti-S1/S2 IgG production in COVID-19-experienced patients after the first shot of the BNT162b2 mRNA COVID-19 Vaccine.

Clin Infect Dis. ()Tre-Hardy M Wilmet A Beukinga I Dogne JM Douxfils J Blairon L.

Validation of a chemiluminescent assay for specific SARS-CoV-2 antibody.

Clinical chemistry and laboratory medicine: CCLM /FESCC. 58 (): 1357-1364Article InfoPublication HistoryPublication stageIn Press Journal Pre-ProofIdentification

DOI: https://doi.org/10.1016/j.jinf.2021.07.001

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